title: A systematic review and meta-analysis of new interventions for peripheral intravenous cannulation of children.
abstract: OBJECTIVE
  Establishing intravenous access in children is often challenging for health professionals. Multiple attempts at peripheral intravenous cannulation (PIVC) cause increased pain and delayed delivery of therapy. Our objective was to synthesize and evaluate the best evidence for novel interventions designed to improve pediatric PIVC.
  
  
  METHODS
  We searched for published and unpublished studies using MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, CINAHL, Web of Science, ClinicalTrials.gov, and Google.ca. We included studies for meta-analysis if they were randomized, evaluated an intervention other than ultrasound, and reported on 1 of 3 primary outcome measures: success or failure of PIVC, number of attempts to successful cannulation, and procedure time. Two blinded reviewers assessed studies for eligibility and applied a data extraction form to those included. Study quality was assessed using the Cochrane Risk of Bias Tool.
  
  
  RESULTS
  Seven studies met the inclusion criteria. Randomized controlled trials (RCTs) of 3 different interventions were identified. A meta-analysis of 3 RCTs found that use of a transilluminator was associated with a decreased risk of first-attempt PIVC failure (risk ratio, 0.66; confidence interval, 0.41-1.06). Meta-analysis of 3 other RCTs found that near-infrared light devices do not impact the risk of first-attempt PIVC failure (risk ratio, 0.99; confidence interval, 0.74-1.33).
  
  
  CONCLUSIONS
  Near-infrared light devices might be efficacious in selected subpopulations, but the available evidence does not support an overall benefit in the pediatric population. Transilluminators modestly improve pediatric PIVC, but the clinical significance of this benefit is questionable. Nitroglycerin ointments may increase the risk of PIVC failure and are associated with adverse effects.
authors.affiliation: Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. jheinric@ualberta.ca
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Heinrichs
authors.forename: Zachary
authors.initials: Z
authors.lastname: Fritze
authors.forename: Terry
authors.initials: T
authors.lastname: Klassen
authors.forename: Sarah
authors.initials: S
authors.lastname: Curtis
mesh_terms: D002648:Child; D006801:Humans; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods / Q000639:trends; D004867:Equipment Design; D007262:Infusions, Intravenous / Q000295:instrumentation; D062069:Inventions; D005996:Nitroglycerin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D009824:Ointments; D016032:Randomized Controlled Trials as Topic; D016037:Single-Blind Method; D014172:Transillumination / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D014664:Vasodilation; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D005996:Nitroglycerin; D009824:Ointments; D014665:Vasodilator Agents